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Назва наукового напрямку (модуля): Семестр: 12 Internal medicine_Module4_ CM2 (short tests) Опис: 12 cеместр Перелік питань: 1. A. B. C. * D. E. 2. A. B. C. * D. E. 3. A. B. C. D. E. * 4. A. * B. C. D. E. 5. A. B. C. D. E. * 6. A. B. C. * A patient with pneumonia is receiving supplemental oxygen, 2 L/min via nasal cannula. The patient’s history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these findings, the physician closely monitors the oxygen flow and the patient’s respiratory status. Which complication may arise if the patient receives a high oxygen concentration? Apnea Anginal pain Respiratory alkalosis Metabolic acidosis None of above A patient with chronic obstructive pulmonary disease (COPD) and a history of coronary artery disease is receiving aminophylline, 25mg/hour. Which one of the following findings would require immediate intervention? Decreased blood pressure and respirations Flushing and headache Restlessness and palpitations Increased heart rate and blood pressure None of above A patient presents with acute exacerbation of chronic bronchitis associated with COPD. If there is evidence of bacterial infection (e.g. purulent sputum), which of the following antibiotics would NOT be recommended for treatment? Ofloxacin Macropen Levofloxacin Doxycycline Vancomycine An elderly postoperative patient has a history of chronic obstructive pulmonary disease. Based on this history, the physician is especially concerned with monitoring the patient for which problem? Aspiration Delirium Decreased gas exchange Positioning difficulty None of above A homeless alcoholic with a chronic productive cough, presents with haemoptysis. The chest X-ray shows a cavitating lesion. Choose the single most likely cause of the disease Haemophilus influenzae Streptococcus pneumoniae Pneumocystis carinii Legionella pneumoniae Mycoplasma tuberculosis A chronic smoker with COPD develops a fever. He reports bringing up green phlegm on coughing. Choose the single most likely cause of the disease Staphylococcus aureus Streptococcus pneumoniae Haemophilus influenzae D. E. F. G. * H. I. J. K. 7. A. * B. C. D. E. 8. A. * B. C. D. E. 9. A. B. C. D. E. * 10. A. * B. C. D. E. 11. A. 12. Mycoplasma tuberculosis Chlamydia trachomatis A 30-yr-old IV drug abuser presents with dyspnoea and haemoptysis. His CXR is unremarkable and ECG shows sinus tachycardia with a mean P axis shift to the right. ABG shows a low PaCO2 and an elevated pH. Pulmonary embolism was suspecteChoose the single most likely investigation Pulmonary angiogram Bronchography Sputum cytology Tissue biopsy Urinalysis A 50-yr-old man' presents with occasional haemoptysis and chronic productive cough. He has a history of recurrent pneumoniCXR reveals peribronchial fibrosis. Bronchiectasis are suspected. Choose the single most likely investigation CT chest 12 lead ECG Clotting studies Sputum cytology Urinalysis A 32-yr-old woman who works in a pet shop complains of fever, a dry cough and increasing breathlessness. Choose the single most likely cause of the disease Chlamydia psittaci Mycoplasma tuberculosis Klebsiella pneumoniae Staphylococcus aureus Haemophilus influenzae 60-yr-old male non-smoker: PFTs—FEV: 4 I, FVC—5 I, FEV1/FVC—40%. After bronchodilator trial—FEV1/FVC—50%. After 2 weeks of Prednisolone 30 mg daily FEV1/FVC = 65%. Choose the single most likely diagnosis Pulmonary haemorrhage Pulmonary embolism Chronic bronchitis Extrinsic tracheal compression Asthma A 35-yr-old woman after thoracic chest injury and hemoptysis: ABG—pH 4, pCO2—4, pO2—4, TLCO—90% of predicted, KCO—160% of predicted. All results were normal 24 hours ago. Choose the single most likely diagnosis Pulmonary haemorrhage Pulmonary embolism Chronic bronchitis Extrinsic tracheal compression Asthma A 56-yr-old man wheezes and coughs. He has tried to give up smoking, but he finds it very difficult. He is thin and healthy looking with a rounded chest. His breathing is noisy. His cough is unproductive. Choose the single most likely management A young male homosexual with Kaposi's sarcoma complains of increasing breathlessness and a dry cough. Choose the single most likely cause of the disease A. B. C. * D. E. 13. A. B. * C. D. E. 14. A. B. C. * D. E. 15. A. B. * C. D. E. 16. A. * B. C. D. E. 17. A. B. C. * D. E. 18. A. Chlamydia trachomatis Haemophilus influenzae Pneumocystis carinii Staphylococcus aureus Streptococcus pneumoniae A 30-yr-old woman has just returned from a holiday in Cyprus. She complains of a dry cough, fever, malaise. A CXR shows patchy consolidation. Choose the single most likely cause of the disease Streptococcus pneumoniae Legionella pneumoniae Haemophilus influenzae Mycoplasma tuberculosis Chlamydia trachomatis Patient N., 45 y.o., has an acute onset of pneumonia with high fever and chills and rusty sputum. The X-ray shows right lower lobe consolidation. Choose the single most likely cause of the disease Staphylococcus aureus Mycobacterium tuberculosis Streptococcus pneumoniae Pneumocystis carinii Esherihia coli A 26-yr-old man presents with severe shortness of breath and dry cough, which he has had for 24 hr. He is very distressed. He has been an IV drug abuser. The X-ray shows perihilar fine mottling. Choose the single most likely cause of the disease Mycobacterium tuberculosis Staphylococcus aureus Haemophilus influenzae Pneumocystis carinii Legionella Previously well 18-yr-old has had influenza for the last 2 weeks. She is deteriorating and has a swinging fever. She is coughing up copious purulent sputum. CXR shows cavitating lesions. Choose the single most likely cause of the disease Staphylococcus aureus Pneumocystis carinii H influenzae Streptococcus pneumoniae Mycoplasma pneumoniae A 64-yr-old man with COPD presents with pneumoniClinically he improves with antibiotics. In the outpatient clinic 4 weeks later, the consolidation on his CXR has not resolved. Choose the single most likely cause of the disease Pneumonia Bronchiectasis Lung cancer Bronchial asthma Tuberculosis A 52-yr-old woman on HRT presents with swollen left calf, chest pain and shortness of breath. Choose the single most likely diagnosis Bronchogenic carcinoma B. C. D. * E. 19. A. B. C. * D. E. 20. A. B. * C. D. E. 21. A. B. C. * D. E. 22. A. * B. C. D. E. 23. A. B. * C. D. E. 24. A. * B. C. D. Pulmonary oedema Pleural effusion Pulmonary embolism Pneumonia A 78-yr-old man has been short of breath for a few weeks. His chest radiography shows a right basal shadow rising towards axilla. Choose the single most likely diagnosis Bronchogenic carcinoma Pulmonary oedema Pleural effusion Pulmonary embolism Pneumonia A 34-yr-old tall slim porter presents with sudden onset of chest pain and breathlessness. He has had similar episodes in the past. Choose the single most likely diagnosis Bronchial asthma Pneumothorax Pleural effusion COPD Pneumonia A 76-yr-old man presents with acute breathlessness, cough, frothy blood stained sputum and palpitations. He is apyrexial. ECG shows sinus tachycardia. Choose the single most likely diagnosis Bronchial asthma Pneumothorax Pulmonary oedema COPD Pneumonia A 37-yr-old man presents with dyspnoea, cough, weight loss and night sweats. His CXR shows diffuse bilateral infiltrates. Choose the single most likely diagnosis Chlamydia psittaci Staphylococcus aureus Streptococcus pneumoniae Pneumocystis carinii Pseudomonas aeruginosa A 48-yr-old man presents with fever, rigors, headache and diarrhoea. He recently had been on a holiday abroad. CXR shows consolidation. Choose the single most likely diagnosis Staphylococcus aureus Legionella pneumophilia Streptococcus pneumoniae Pneumocystis carinii Pseudomonas aeruginosa A 24-yr-old man with dry cough, skin manifestations and bone and muscle aches. His chest radiograph shows widespread patchy shadows. Blood tests show evidence of haemolysis. Choose the single most likely diagnosis Mycoplasma pneumoniae H. influenzae Streptococcus pneumoniae Pneumocystis carinii E. 25. A. * B. C. D. E. 26. A. B. C. D. E. * 27. A. B. C. D. * E. 28. A. B. C. D. * E. 29. A. B. C. D. E. * 30. A. * B. C. D. E. 31. A. * Pseudomonas aeruginosa A 45-yr-old farmer presents with flu-like illness anorexia and dry cough. His OCR shows patchy consolidation. Choose the single most likely diagnosis Mycoplasma pneumoniae H. influenzae Streptococcus pneumoniae Pneumocystis carinii Pseudomonas aeruginosa A 41-yr-old drug abuser presents with fever, cough and breathlessness. This was preceded by viral influenza. Chest radiograph shows multiple abscesses. Choose the single most likely diagnosis Pseudomonas aeruginosa H. influenzae Streptococcus pneumoniae Pneumocystis carinii Staphylococcus aureus A 24-yr-old student with cystic fibrosis rapidly deteriorated and developed acute respiratory failure while in hospital. Choose the single most likely diagnosis Pneumocystis carinii H. influenzae Mycobacterium tuberculosis Pseudomonas aeruginosa Streptococcus pneumoniae A 69-yr-old woman who had a total hip replacement a week ago presents with severe chest pain, shortness of breath and haemoptysis. Choose the single most likely diagnosis Bronchiectasis Bronchogenic carcinoma Tuberculosis Pulmonary infarction Pneumonia A 52-yr-old diabetic presents with fever, pleuritic pain and rusty coloured sputum. Choose the single most likely diagnosis Bronchiectasis Bronchogenic carcinoma Tuberculosis Pulmonary infarction Pneumonia A 30-yr-old woman presents with fever, pharyngitis and cough. The CXR shows widespread bilateral patchy consolidation. Erythema multiforme is present. Choose the single most likely cause of her state Mycoplasma pneumoniae Bronchial asthma Pneumoconiosis COPD Pleurisy A 35-yr-old pet shop owner presents with high fever, excruciating headache and a dry hacking cough. The CXR shows patchy consolidation. Choose the single most likely etiology of the disease Chlamydia psittaci B. C. D. E. 32. A. B. * C. D. E. 33. A. * B. C. D. E. 34. A. B. C. D. * E. 35. A. * B. C. D. E. 36. A. * B. C. D. E. 37. A. B. C. D. * Streptococcus pneumoniae Pseudomonas aeruginosa Actinomycosis Staphylococcus aureus A 70-yr-old woman presents with confusion and productive cough. CXR shows right lower lobe consolidation. Choose the single most likely etiology of the disease Aspergillosis Streptococcus pneumoniae Staphylococcus aureus H. influenzae Esherihia coli A 70-yr-old alcoholic man presents with sudden onset of purulent productive cough. CXR shows consolidations left upper lobe. Choose the single most likely etiology of the disease Klebsiella pneumonia Pneumocystis carinii CMV Chlamydia Actinomyces A 20-yr-old male IV drug abuser presents with breathlessness and cough. CXR reveals patchy areas of consolidation with abscess formation. Choose the single most likely etiology of the disease Streptococcus pneumoniae Pneumocystis carinii CMV Staphylococcus aureus Haemophilus influenzae An 18-yr-old teenager with cystic fibrosis presents with a chest infection. Pseudomonas infection was diagnosed.The teenager also suffers from mild renal failure. Choose the single most likely treatment Ciprofloxacin Rifampicin + Isoniazid Prednisolone Beta 2 agonist Cyclophosphamide A 40-yr-old mental patient with dry cough and confusion. Blood tests reveal lymphopenia and hyponatraemia. CXR shows right lobar shadowing. Legionelia pneumonia was diagnosed. Choose the single most likely treatment Erythromycin Rifampicin + Isoniazid Prednisolone Beta 2 agonist Cyclophosphamide A 23-yr-old man presents with wheezing attacks and episodic shortness of breath. His PEFR is 400 L/min. Choose the single most likely treatment Erythromycin Plasmaphoresis Tetracycline Beta 2 agonist E. 38. A. B. C. * D. E. 39. A. * B. C. D. E. 40. A. * B. C. D. E. 41. A. B. * C. D. E. 42. A. B. C. * D. E. 43. A. B. * C. D. Cyclophosphamide A 37-yr-old man who has had recurrent chest infections since a serious bout of influenza 3-yr ago presents with chronic productive cough. His sputum is tenacious and blood stained. On auscultation you find crackling. Choose the single most likely management Surgical excision Chest wall drain Postural drainage Salbutamol Pleurectomy A 18-yr-old girl has severe cough and fever. She appears acutely ill and cyanosed. Choose the single most likely diagnosis Respiratory syncytial virus Bronchogenic carcinoma Pleural effusion Tuberculosis Bronchiectasis A 38-yr-old sailor presents with a dry cough of sudden onset. He complains of a chest pain and rusty sputum. He also has a very high fever, rapid breathing, cyanosis and crepitations. Choose the single most likely cause of his disease Pneumococci S. aureus M. tuberculosis Klebsiella Esherihia coli A 54-yr-old farmer with intermittent dry cough fever and dyspnoea progressive weight loss and fine crepitations on auscultation. Extrinsic allergic alveolitis (Farmer’s lung) is suspected. Choose the single most likely investigation Mantoux test Serum precipitins and high resolution CT Fibreoptic bronchoscopy Sputum culture Arterial blood gases A 30-yr-old woman presents with a 3-day history of pyrexia, rigors and sweats. This was preceded by a 1 week history of cough and increasing dyspnoea. She had a swinging fever and dullness to percussion at the left lung base. Choose the single most likely diagnosis Pleural metastases Bronchial asthma Pneumonia Emphysema Cardiac failure A 50-yr-old man became suddenly breathless whilst eating. He has marked stridor and is choking and drooling. Foreign body obstructing bronchial airway is diagnosed. Choose the single most likely management Nebulised salbutamol Heimlich manoeuvre Rapid infusion of saline IV Adrenaline E. 44. A. * B. C. D. E. 45. A. B. C. D. * E. 46. A. * B. C. D. E. 47. A. B. C. D. * E. 48. A. B. * C. IV Furosemide A 20-yr-old woman is too breathless to speak. Her pulse is 120/min respiratory rate 30/min and PEFR is 100 l/min. Examination reveals a very quiet chest and CXR is normal. Acute asthma attack is diagnosed. Choose the single most likely management Nebulised salbutamol Heimlich manoeuvre Rapid infusion of saline IV Adrenaline IV Furosemide A 36-year-old woman has had increasing dyspnea for 8 years. She has cough and increased sputum production. On physical examination there is hyperresonance to percussion. A chest radiograph reveals increased lung volumes with flattening of the diaphragmatic leaves bilaterally. The right heart border is prominent. Which of the following laboratory findings is she most likely to have? Decreased serum ceruloplasmin Increased sweat chloride Elevated blood ethanol Decreased serum alpha-1-antitrypsin Positive urine opiates A 40-year-old woman has had a high fever for a week, accompanied by a cough productive of yellowish sputum. On physical examination her temperature is 2 C. There are diffuse rales in all lung fields. Her chest radiograph reveals patchy infiltrates in all lung fields, and there is a 4 cm rounded area of consolidation in the left upper lobe that has an air-fluid level. Examination of her sputum reveals numerous neutrophils. Which of the following infectious agents is most likely causing her pulmonary disease? Staphylococcus aureus Hemophilus influenzae Mycobacterium tuberculosis Mycoplasma pneumoniae Adenovirus A 19-year-old girl has the acute onset of dyspnea and wheezing. She coughs up a large, thick mucus plug. She has experienced similar previous episodes for the past 7 years, all of which lasted 1 to 6 hours. On physical examination her vital signs include T 1 C, P 109/minute, RR 27/minute, and BP 90/60 mm Hg. There are decreased breath sounds in all lung fields. A chest radiograph reveals hyperinflation but no infiltrates. Laboratory studies show WBC count of 8300/microliter with differential count of 60 segs, 3 bands, 16 lymphs, 10 monos, and 11 eosinophils. A sputum sample examined microscopically has increased numbers of eosinophils. Which of the following is the most Mycoplasma pneumonia infection likely diagnosis? COPD Hypersensitivity pneumonitis Bronchial asthma Aspiration of gastric contents A 45 year old man who is known to be HIV positive is admitted to the medical ward with increasing dyspnoea and a non-productive cough of 3 weeks duration. He has smoked 20 cigarettes a day for 20 years. His temperature is 38c. Breath sounds are normal. Leukocyte count was 5 x 109/L with low neutrophil and lymphocyte count. Sputum examination is normal. Chest X-ray shows bilateral diffuse infiltration. Which of the following is the most likely diagnosis? Tuberculosis Pneumocystis carinii pneumonia Aspergillosis D. E. 49. A. B. * C. D. E. 50. A. B. * C. D. E. 51. A. B. C. * D. E. 52. A. B. C. D. * E. 53. A. * B. C. D. E. 54. Bronchiectasis Carcinomatous infiltration of lung A 17 year young man has clubbing, tachypnoea and hyperinflation of his chest. His temperature is 5c. On auscultation, there are widespread crackles. He has been coughing up copious amount of thick, green sputum for the past year. His stools are pale, offensive smelling and do not flush easily. Which of the following is the most likely organism isolated from his sputum? Respiratory syncytial virus Pseudomonas sp Streptococcus pneumoniae Mycobacterium tuberculosis Chlamydia pneumoniae A 71 year old woman with a history of alcohol abuse presenting with 5 days of fever, right sided pleuritic chest pain and coughing up rusty-coloured sputum. A sputum gram stain shows large numbers of gram positive cocci. Which of the following pathogens is most likely to be the cause of pneumonia? Staphylococcus aureus Streptococcus pneumoniae Pneumocystis carinii Pseudomonas aeruginosa Legionella sp. A 49 year old homosexual man, recently diagnosed with HIV infection admitted with a dry cough, shortness of breath and fever. Pulse oximetry shows oxygen saturations of 86% on room air. Which of the following pathogens is most likely to be the cause of pneumonia? Pseudomonas aeruginosa Streptococcus pneumoniae Pneumocystis carinii Influenza virus Haemophilus influenzae . A 23 year old man ventilated on an ICU following a head injury, showing increased oxygen requirements, and a left sided infiltrate on a chest x-ray. A bronchial lavage specimen reveals gram negative bacilli. Which of the following pathogens is most likely to be the cause of pneumonia? Candida albicans Streptococcus pneumoniae Haemophilus influenzae Pseudomonas aeruginosa Staphylococcus aureus A previously fit 46 year old man who has recently returned from a holiday in Spain, is admitted with a dry cough, fever, abdominal pain and malaise. Initial blood tests show he is in renal failure with a creatinine of 380imol/l and hyponatraemia with a plasma sodium of 119 mmol/l. Three other friends who stayed in the same hotel have also developed a severe pneumonia. Which of the following pathogens is most likely to be the cause of pneumonia? Legionella sp. Streptococcus pneumoniae Haemophilus influenzae Influenza virus Mycobacterium tuberculosis A 23-yr-old male patient has just returned from holiday abroad presents with flu-like illness, headaches, high fever prior to this, he had complained of abdominal pain, vomiting, diarrhoea associated with blood per rectum. Choose the single most likely cause of the disease A. B. C. D. * E. 55. A. * B. C. D. E. 56. A. B. C. * D. E. 57. A. B. C. D. * E. 58. A. * B. C. D. E. 59. A. * B. C. D. E. Staphylococcus aureus Streptococcus pneumoniae H influenzae Legionella pneumoniae Pneumocystis carinii A 35-yr-old previously healthy man returned from holiday five days ago. He smokes 10 cigarettes per day. He presents with mild confusion, a dry cough and mild pyrexia. His chest is normal. The X-ray shows widespread upper zone shadowing. Choose the single most likely cause of the disease Legionella Staphylococcus aureus Haemophilus influenzae Pneumocystis carinii Streptococcus pneumoniae A 65-yr-old man currently undergoing chemotherapy of chronic leukaemia has felt unwell with fever and unproductive cough for 2 weeks despite treatment with broad-spectrum IV antibiotics. The CXR shows an enlarging right sided mid zone consolidation. Choose the single most likely cause of the disease Staphylococcus aureus Pneumocystis carinii Fungi Streptococcus pneumoniae Mycoplasma pneumoniae A 27-yr-old male prostitute has felt generally unwell for 2 months with some weight loss. Over the last 3 weeks he has noticed a dry cough with increasing breathlessness. Two courses of antibiotics from the GP have produced no improvement. The CXR shows bilateral interstitial infiltrates. Choose the single most likely cause of the disease Staphylococcus aureus Streptococcus pneumoniae H influenzae Pneumocystis carinii Mycoplasma pneumoniae On return to university, a 20-yr-old student presented with the onset of fever, malaise and a dry cough. The student health service gave him Amoxycilin. After a week he felt no better and his CXR showed patchy bilateral consolidation. Choose the single most likely cause of the disease Mycoplasma pneumoniae Streptococcus pneumoniae H influenzae Pneumocystis carinii Staphylococcus aureus A 37-yr-old farmer presented with fever, malaise, cough and breathlessness, which he had had for a few days. His symptoms were worse in the evening. Clinical examination demonstrated coarse end inspiratory crackles. Choose the single most likely diagnosis Extrinsic allergic alveolitis Pulmonary oedema Pleural effusion COPD Pneumonia 60. A. * B. C. D. E. 61. A. * B. C. D. E. 62. A. B. * C. D. E. 63. A. B. C. * D. E. 64. A. * B. C. D. E. 65. A. * B. C. A 50-yr-old man who works in an abattoir presents with sudden onset of fever, myalgia, headache, dry cough and chest pain. CXR shows patchy consolidation of the right lower lobe giving a ground glass appearance. Choose the single most likely etiology of the disease Coxiella burnetti Streptococcus pneumoniae Staphylococcus aureus H. influenzae Esherihia coli A 44-yr-old travelling insurance salesman presents with high fever myalgia abdominal pain and haemoptysis. CXR shows diffuse patchy lobar shadows. The cough progresses from a modest nonproductive cough to producing mucopurulent sputum. The fever persists for 2 weeks. Choose the single most likely etiology of the disease Legionella pneumophilia Streptococcus pneumoniae Staphylococcus aureus H. influenzae Esherihia coli A 42-yr-old man with AIDS presents with fever, dry cough and dyspnoe CXR shows diffuse bilateral alveolar and interstitial shadowing beginning in the perihilar regions and spreading outward. Choose the single most likely etiology of the disease Streptococcus pneumoniae Pneumocystis carinii CMV Staphylococcus aureus Haemophilus influenzae A 60-yr-old farmer presents with fever, cough and shortness of breath. He had been forking hay that morning. CXR shows fatty nodular shadows in the upper zone. Extrinsic allergic alveolitis (Farmer’s lung) was diagnosed. Choose the single most likely treatment Ciprofloxacin Rifampicin + Isoniazid Prednisolone Beta 2 agonist Tetracycline A 30-yr-old IV drug abuser presents with dyspnoea and haemoptysis. His CXR is unremarkable and ECG shows sinus tachycardia with a mean P axis shift to the right. ABG shows a low PaCO2 and an elevated pH. Pulmonary embolism was suspected. Choose the single most likely investigation Pulmonary angiogram Bronchography Sputum cytology Tissue biopsy Urinalysis A 40-yr-old man' presents with occasional haemoptysis and chronic productive cough. He has a history of recurrent pneumoniCXR reveals peribronchial fibrosis. Bronchiectases are suspected. Choose the single most likely investigation CT chest 12 lead ECG Clotting studies D. E. 66. A. B. C. D. E. * 67. A. * B. C. D. E. 68. A. B. * C. D. E. 69. A. B. C. D. * E. 70. A. B. C. D. * E. 71. Sputum cytology Urinalysis 58-yr-old male non-smoker: PFTs—FEV: 4 I, FVC—5 I, FEV1/FVC—40%. After bronchodilator trial—FEV1/FVC—50%. After 2 weeks of Prednisolone 30 mg daily FEVj/FVC = 65%. Choose the single most likely diagnosis Pulmonary hemorrhage Pulmonary embolism Chronic bronchitis Extrinsic tracheal compression Asthma A 45-yr-old woman after thoracic chest injury and hemoptysis: ABG—pH 4, pCO2—4, pO2—4, TLCO—90% of predicted, KCO—160% of predicted. All results were normal 24 hours ago. Choose the single most likely diagnosis Pulmonary haemorrhage Pulmonary embolism Chronic bronchitis Extrinsic tracheal compression Asthma A 22-yr-old car mechanic is brought to casualty by his girlfriend. She describes a 2-day history of rigors, sweats and intermittent confusion. On examination he is agitated, sweaty and pyrexial with 6° C. He is hyperventilating and cyanosed despite receiving O2 by face mask. There is dullness to percussion and bronchial breathing at the left lung base. Left lower lobe pneumonia was suspected. Choose the single most likely investigation Urea and electrolytes Chest X-ray Spiral CT with contrast Blood count and film ECHO A 47-yr-old man wheezes and coughs. He has tried to give up smoking, but he finds it very difficult. He is thin and healthy looking with a rounded chest. His breathing is noisy. His cough is unproductive. Choose the single most likely management Prednisolone Amoxycillin Postural drainage Salbutamol Pleurectomy A middle-aged smoker presents with chronic cough and phlegm. His sputum is tenacious but not yellow or blood stained. His chest is hyperinflated. His arterial carbon dioxide is high and is arterial oxygen is low. Choose the single most likely diagnosis Tuberculosis Pulmonary embolism Bronchial asthma COPD Pneumonia A 43-yr-old shipyard worker complains of gasping for breath. On physical examination you discover mild cyanosis and restricted chest movements. Respiratory distress is present. Choose the single most likely management A. B. C. D. E. * 72. A. B. C. * D. E. 73. A. * B. C. D. E. 74. A. B. C. * D. E. 75. A. B. C. * D. E. 76. A. B. C. D. * E. 77. A. * B. Anticoagulants Chemotherapy Radiotherapy A healthy diet Oxygen therapy A 50-yr-old with pulmonary fibrosis develops sudden left-sided pleuritic chest pain and dyspnoea. He has reduced air entry in the left side of the chest and percussion is hyper-resonant. O2 saturation is 80%. Pneumothorax is diagnosed. Choose the single most likely management Nebulised salbutamol Heimlich manoeuvre Pleural aspiration High flow oxygen and anticoagulation IV Adrenaline An old woman complains of wheeze, dyspnoea and cough. She cannot sleep at night because of a chronic cough. Her CXR suggests hyperinflation. Spyrography: FEV1, FVC, Typhno index are low. What is the previous diagnosis? COPD Bronchogenic carcinoma Emphysema Respiratory failure Bronchial asthma A 8-yr-old girl with cystic fibrosis presents with a chest infection. The girl also suffers from mild renal failure. Choose the most appropriate treatment Erythromycm Tetracycline Ciprofloxacin Flucoxacillin All of the above A 24-yr-old woman presents with a week's history of fever, rigors arid productive rusty cough. CXR shows right lower lobe consolidation. What is the previous diagnosis? COPD Emphysema Pneumonia Bronchial asthma Non above A 24-yr-old woman presents with a week's history of fever, rigors arid productive rusty cough. CXR shows right lower lobe consolidation. Prescribe treatment. Co-trimoxazole Prednisolone Penicillin Azitromycin Non above A 25-yr-old man has a 3-day history of shivering, general malaise and productive cough. The chest X-ray shows right lower lobe consolidation. What is the possible diagnosis? Pneumonia Emphysema C. D. E. 78. A. * B. C. D. E. 79. A. B. C. * D. E. 80. A. * B. C. D. E. 81. A. * B. C. D. E. 82. A. * B. C. D. E. 83. A. * B. C. D. COPD Lung abscess Respiratory failure A 35-yr-old woman has a 3-day history of shivering, general malaise and productive cough. The chest X-ray shows right lower lobe consolidation. What is the most possible cause of the disease? Streptococcus pneumoniae Mycobacterium tuberculosis Coxiella burnetti Pneumocystis carinii Bacteroides fragilis A 35-yr-old man presents with a 3-day history of pyrexia, rigors and sweats. This was preceded by a 1 week history of cough and increasing dyspnea. She had a swinging fever and dullness to percussion at the left lung base. Previous diagnosis? Emphysema Tuberculosis Pneumonia Bronchial carcinoma Non above A 38-yr-old pet shop owner presents with high fever, excruciating headache and a dry hacking cough. The CXR shows patchy consolidation. Which infection is the most possible cause of his state? Chlamydia psittaci Coxiella burnetti Staphylococcus aureus Pneumocystis carinii Aspergillosis A 33-yr-old man presents with dyspnoea, cough, weight loss and night sweats. His CXR shows diffuse bilateral infiltrates. Which infection is the most possible cause of his state? Chlamydia psittaci Mycoplasma pneumoniae Pneumocystis carinii coli Pseudomonas aeruginosa A 31-yr-old drug abuser presents with fever, cough and breathlessness. This was preceded by viral influenza. Chest radiograph shows multiple abscesses. Which infection is the most possible cause of his state? Staphylococcus aureus Crytococcus Streptococcus pneumoniae Legionella pneumoniae Mycobacterium avium A 38-yr-old farmer presents with flu-like illness anorexia and dry cough. His CXR shows patchy consolidation. Which infection is the most possible cause of his state? Mycoplasma pneumoniae Pneumocystis carinii Chlamydia psittaci coli E. 84. A. * B. C. D. E. 85. A. * B. C. D. E. 86. A. * B. C. D. E. 87. A. * B. C. D. E. 88. A. * B. C. D. E. 89. A. * B. C. D. E. Pseudomonas aeroginosa A 74-yr-old woman presents with confusion and productive cough. CXR shows right lower lobe consolidation. What is the possible cause of the disease? Streptococcus pneumoniae Chlamydia psittaci Staphylococcus aureus Pneumocystis carinii Mycobacterium tuberculosis A 74-yr-old woman presents with confusion and productive cough. CXR shows right lower lobe consolidation. What is the possible diagnosis? Pneumonia COPD Emphysema Pulmonary embolism Asthma A chronic smoker 57 years old with COPD develops a fever. He reports bringing up green phlegm on coughing. Which infection is the most possible cause of his state? Haemophilus influenzae Mycoplasma tuberculosis Haemophilus influenzae Pneumocystis carinii Klebsiella pneumoniae A young male, 25 years old, homosexual with Kaposi's sarcoma complains of increasing breathlessness and a dry cough. The X-ray shows right lower lobe consolidation. Which infection is the most possible cause of his state? Pneumocystis carinii Mycoplasma tuberculosis Haemophilus influenzae Chlamydia trachomatis Klebsiella pneumoniae Drug abuser, a 41-yr-old man, presents with fever, cough and breathlessness. This was preceded by viral influenza. Chest radiograph shows multiple abscesses. What is the most possible etiology of disease? Staphylococcus aureus Cryptococcus Streptococcus pneumoniae Legionella pneumoniae Mycobacterium avium Drug abuser, a 47-yr-old man, presents with fever, cough and breathlessness. This was preceded by viral influenza. Chest radiograph shows multiple abscesses. What is the most possible etiology of disease? Staphylococcus aureus Cryptococcus Streptococcus pneumoniae Legionella pneumoniae Mycobacterium avium 90. A. * B. C. D. E. 91. A. * B. C. D. E. 92. A. B. * C. D. E. 93. A. B. C. * D. E. 94. A. * B. C. D. E. 95. A. B. C. * D. E. 96. A. B. * Patient has fever, dry cough, dyspnea increases. Most of the time she lies on one side. Auscultation and percussion data let to suspect an exudative pleurisy. What method of investigation will confirm a diagnosis? Chest X-ray Pneumotachometry Spyrometry Bronchography Bronchoscopy Patient is ill with COPD for 30 years. He usually products approximately 0,5 l of purulent sputum every day with the maximal production in the morning; fingers are like "drumsticks", nails are like "sentinel glass". What disease is possible? Bronchiectasis Pneumonia Chronic bronchitis Gangrene of lungs Tuberculosis The 82-year-old patient has a pulmonary infection. Which action addresses the age-related change of increased vascular resistance to blood flow through pulmonary vasculature in this patient? Encouraging the patient to turn, cough, and deep breathe every hour Assessing the patient's level of consciousness Raising the head of the bed Humidifying the oxygen Non of above Which clinical manifestation in a patient with chronic bronchitis indicates to you a worsening of the patient's respiratory condition? Fatigue Cachexia Confusion Slow capillary refill Non of above A 70-yr-old alcoholic man presents with sudden onset of purulent productive cough. CXR shows consolidations at left upper lobe. Which infection is the most possible cause of his state? Klebsiella Chlamydia psittacci Staphylococcus aureus Pneumocystis carinii Aspergillosis The following drug is licensed for the management of COPD: montelukast nedocromil sodium salbutamol cromolyn sodium none of above The following clinical features are common in COPD: Symptoms under age 35 chronic productive cough C. D. E. 97. A. * B. C. D. E. 98. A. B. C. * D. E. 99. A. B. C. D. * E. 100. A. B. C. * D. E. 101. A. B. C. * D. E. 102. A. B. C. * D. E. 103. A. B. C. * night time wakening with breathlessness and wheeze significant diurnal or day to day variability of symptoms all of above Which laboratory results are consistent with longterm COPD? Erythrocytosis Erythrocytopenia Hypocapnia Leukopenia Hyperglycemia A patient has COPD and a barrel chest. Which finding would the physician expect when assessing the chest? Paradoxical chest movement Presence of a friction rub Decreased respiratory excursion Absent breath sounds None of above Which would be an expected effect of resistive breathing training in a patient with COPD? Energy conservation Increased oxygen saturation Decreased hypercarbia Increased respiratory muscle strength None of above An elderly patient is on an anticholinergic metered dose inhaler (MDI) for chronic obstructive pulmonary disease. The physician would suggest a spacer to enhance the administration of the medication increase patient compliance improve aerosol delivery in patients who are not able to coordinate the MDI prevent exacerbation of COPD none of above What is the most common cause of chronic obstructive pulmonary disease (COPD)? Bronchiectasis Chronic bronchitis Cigarette smoking Emphysema Asthma Alpha, 1-antitrypsin deficiency is associated with: bronchial asthma a late onset of dyspnea upon exertion COPD pneumonia gastrointestinal malabsorption In which of the following conditions can central cyanosis be detected? methemoglobinemia ventilation-perfusion mismatch pulmonary arteriovenous fistula D. E. 104. A. B. C. * D. E. 105. A. B. C. * D. E. 106. A. B. C. D. E. * 107. A. B. C. D. * E. 108. A. B. C. * D. E. 109. A. * B. C. D. E. 110. A. * B. C. D. E. 111. general overcooling heavy physical exercise Characteristics of mediastinal emphysema include all EXCEPT: marked suprasternal pulsation Hamman's sign (a crackling sound synchronous with cardiac systole) pain in the throat gas under the diaphragm cyanosis Characteristics of mediastinal emphysema include all EXCEPT: marked suprasternal pulsation Hamman's sign (a crackling sound synchronous with cardiac systole) arterial hypertension gas under the diaphragm cyanosis The side effects of corticosteroids include all EXCEPT: arterial hypertension cataract ostheoporosis hyperglycemia cachexy Recognized cause of recurrent pneumonia include: Chronic alcoholism Multiple myeloma Anemia Esophageal lesions and aspiration of its content Silicosis Klebsiella-pneumonia: is usually mild is frequently associated with a collapse of the upper lobe frequently causes lung abscesses despite therapy the mortality is 50% most commonly develops in youngsters Bilateral pleural effusion is observed in all states EXCEPT: left-sided pneumonia sytemic lupus erythematosus miliary tuberculosis carcinomatous lymphangitis chronic cardiac failure Bilateral pleural effusion is observed in all states EXCEPT: monolobar pneumonia sytemic lupus erythematosus miliary tuberculosis severe kidney insufficiency chronic cardiac failure Clubbing of the fingers is observed in which of the following conditions? A. B. C. * D. E. 112. A. B. C. * D. E. 113. A. B. C. D. * E. F. 114. A. B. C. D. E. * 115. A. * B. C. D. E. 116. A. B. C. * D. E. 117. A. B. C. D. * E. 118. A. viral pneumonia rheumatoid arthritis bronchiectasis trombemboly of pulmonary artery status asthmaticus Clubbing of the fingers is observed in which of the following conditions? fungal pneumonia rheumatoid arthritis chronic bronchitis trombemboly of pulmonary artery status asthmaticus Characteristic physical symptoms of pneumothorax include all EXCEPT: percussion over the affected side reveals bang-box sound auscultation over the affected side reveals weaker respiratory sounds end-respiratory crepitations are detected the mediastinum is shifted towards the opposite side there are decreased respiratory movements on the affected side Adequate procedures in the treatment of asthmatic crisis include: the inhalation of 40% oxygen if the PaC02 is elevated sedation if the patient is agitated the intravenous administration of hydrocortisone salbutamol inhalation plasmaphorhesis Choose the false answer: COPD is a disease: characterized by reversible airways obstruction which rarely occurs in patients under the age of 35 in which symptoms rarely vary between days which is linked to a chronic productive cough All answers are false Choose the false answer: When the diagnosis of COPD is considered the patient should also be questioned about: occupational history dyspnoea defecation ankle swelling All answers are false Choose the false answer: Possible differential diagnosis considered when diagnosing COPD are: lung cancer bronchial asthma heart failure cystic fibrosis All answers are false Choose the false answer: Smoking cessation: in patients with COPD will return the patients FEV1 to normal for their age B. C. * D. E. 119. A. B. * C. D. E. 120. A. B. C. * D. E. 121. A. B. C. D. E. * 122. A. B. C. D. E. * 123. A. B. C. D. E. * 124. A. * B. C. D. E. 125. A. B. * in patients with COPD will return the rate of decline in FEV1 to normal in patients with COPD will have no effect on lung function is the most beneficial intervention for all patients with COPD All answers are false Choose the false answer: For management of patients with COPD it is necessary: at severe exacerbation of COPD should be prescribed inhaled corticosteroids admitted to hospital with an exacerbation of COPD should be scribed high dosages of oral corticosteroids should be referred pulmonary rehabilitation if they think that they functionally disabled by the disease All answers are true All answers are false Choose the false answer: In the management of COPD it is recommended: the use of as required short acting inhaled beta agonists the use of anticholinergics the use of ipratropium and tiotropium together the use of combination inhalers in moderate to severe disease All answers are false Patients with COPD should only be prescribed: inhaled corticosteroids if they have demonstrable reversibility corticosteroids in an exacerbation if they have had a steroid trial ipratropium if a short acting beta agonist has shown no benefit a long acting beta agonist if they are also receiving an inhaled corticosteroid All answers are false Patients with COPD demonstrate no increase in quality of life: when prescribed inhaled corticosteroids unless they demonstrate sensibility when prescribed tiotropium rather than ipratropium unless their FEV1 is also increased when prescribed a combination of inhaled corticosteroids and long-acting beta agonists All answers are false Patients with COPD who are prescribed long term oxygen therapy at home should: be encouraged to stop smoking use antibiotics at the phase of exacerbation should avoid overcooling should use a compressor and air to drive any nebulised medicines All answers are true Choose the wrong answer: Patients with COPD: should have their nebulised drugs delivered by a nebuliser driven by oxygen should have their nebulised drugs delivered by a nebuliser driven by air which is severe should be prescribed a combination of an inhaled corticosteroid and long acting beta agonist which is moderate to severe should be prescribed tiotropium All answers are wrong Other therapies which have shown usefulness in the management of COPD include all exept: mucolytics diuretics C. D. * E. 130. theophylline adrenomimetics All answers are true One of the assessment criteria which does not favour home management of exacerbations of COPD is that the patient: does not currently receive home oxygen therapy severe breathlessness has an oxygen saturation above 80% mild breathlessness All answers are true All answers are true except: Abrupt withdrawal of prednisolone following management of an exacerbation of COPD: may precipitate a further exacerbation of COPD is acceptable if the patient has been on a high dose for less than 21 days can be undertaken if the patient is not on a maintenance dose of corticosteroids cannot be undertaken if the patient is on high dose inhaled corticosteroids All answers are true Choose the false answer: An infective exacerbation is characterized by: an increased volume of sputum and a cough an increased volume of sputum and increased purulence of sputum an increased volume of sputum and increased breathlessness an increased volume of sputum and increased FEV1 an increased temperature The most common causative organisms of infective exacerbations of COPD are all except: Staphylococcus aureus Streptococcus pneumonia Haemophilus influenzae All answers are false All answers are true An appropriate antibacterial for the management of an exacerbation of COPD are all except: A. B. * amoxicillin 500mg three times a day for a non-penicillin allergic patient amoxicillin 3g twice a day for non-penicillin allergic patients D. E. 126. A. B. * C. D. E. 127. A. B. C. D. * E. 128. A. B. C. D. * E. 129. A. B. C.